BACKGROUND
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LEND Training and Quality Improvement: Building Leadership Skills While Enhancing Patient and Family-Centered Care Claire Beers, Katherine DiNicola, Marjorie Dobra, Robin Gardner, Carrie Goodberlet, Jed Nordfelt, Johanna Stump Lisa DeLucia, Michelle Casey, Mark Orlando, Stephen Sulkes BACKGROUND LEND FELLOW LEARNING OUTCOMES Unsafe Behaviors • Elopement: Nearly half of children with an ASD elope, and more than half of these “go missing.” Elopement is associated with autism severity, and is often goal- directed. (Pediatrics 2012) • Drowning: Children who wander are often drawn to water sources. Accidental Drowning was identified as one of the leading causes of death among children who have a diagnosis of ASD (AWAARE, 2012) • Pica: Prevalence: 25-30% of children who have a diagnosis of ASD Pica can lead to: Lead Poisoning, Bowel Problems, Intestinal Obstructions or Perforations, Dental Problems, and Parasitic Infection • Aggression: Many children who have a diagnosis of an ASD exhibit aggressive behaviors towards those close to them. This can be challenging to Anderson C, Law JK, Daniels A, Rice C, Mandell DS, Hagopian L, Law P. Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders. Pediatrics 11/12; 130(5):1-8, 11/12. AWAARE Collaboration. (2012). Become Aware. Retrieved from http://www.awaare.org/index.htm Centers for Disease Control and Prevention. (2012). New Data on Autism Spectrum Disorders (ASDs). Retrieved from http://www.cdc.gov/Features/CountingAutism / PDSA Cycle Results: Percent Documented Kirch Center Safety Resource List OBJECTIVES – This study Cycle Descriptions: Cycle 1: Baseline One Randomly selected week in October, 2011 22 charts reviewed Cycle 2 : Providers Informed of Activity; no specific intervention proposed After informal presentation to Kirch Practitioners of QI project One randomly selected week in December, 2011 Cycle 3 : Small Group Template Implemented 5 Practitioners volunteered to utilize a Template called “Symptoms” Reviewed from week of January 30, 2012 19 charts reviewed total Cycle 4 : Template Presented to Full Team Formal presentation to Kirch DESIGN/METHODS RESULTS PLAN-DO-STUDY-ACT (PDSA) Cycles A Tool for Incremental Improvement The Problems • The CDC created a new ICD-9 Code for Wandering and Elopement (V40.31) based on the interest and high rates reported by major autism groups (2012). • AWAARE and IAN , for example, reported wandering rates from 50% to high as 92% (2012). • Only 14% of patients said they received information from medical professionals (IAN, 2012). • The Golisano Children’s Hospital Kirch Center serves a large population with Autism Spectrum Disorders and wants to become proactive in using the CDC Codes and promoting understanding about wandering. • Other key autism related safety issues associated with wandering were also identified and incorporated into the study to see if they were being reported and discussed. • Notation in a Medical Center/Community- wide Electronic Medical Record alerts providers in multiple settings of risks Five Chart Reviews / PDSA Cycles were conducted in the Kirch Clinic • Four reviews conducted of all practitioners during follow-up visits • One review conducted of practitioners who volunteered to use behavioral template Chart Selection Criteria: • First two patients over age three seen during that week by each practitioner with diagnosis of ASD or PDD-NOS References Initial clinical team resistance Practitioners tend to focus on what they feel is important during patient visits. Their time is very limited and they like to address the immediate concerns of the patient, leaving less time for documentation of other screening Needed resources to implement changes eRecords was not live during at start of project and AllScripts did not have an easily accessible template. With implementation of new system, quality markedly increased Practitioners, recognized the importance of the risk-areas and given the right tools, change how their practice Produced a safety resource list (paper and electronic) Spread awareness across the Kirch Developmental Center of Autism Risk Areas Wandering Safety: www.AWAARE.org www.Autism_Risk_Management.com www.Project_Lifesaver.org www.UNYFEAT.org (Autism Risk and Safety section) Drowning Prevention and Water Safety: www.warnonline.org/english/index.html autism.fsu.edu/documents/ DrowningBrochureDRAFT.pdf Pica Prevention: www.healthguideinfo.com/autism- treatment/p114419/ SIB and Aggression www.autism.com/ind_self- injurious_behavior_treat.asp http://Autism-help.org/behavior-intro- autism.htm Literature Review Skills Understand Quality Improvement Process and Use of PDSA Cycle Approach to Incremental Change Presentation and Interdisciplinary Team Engagement Skills Quantitative Skills Negotiation and Conflict Resolution Systems Change to Achieve Family- Centered Care Risk Area PDSA #1 % n = 22 PDSA #2 % n = 22 PDSA #3 % n =20 PDSA #4 % n = 19 PDSA #5 % n = 19 Elopement 9 18 32 39 84 Drowning 5 0 0 17 11 Pica 50 23 32 56 36 Aggression 50 50 47 50 63 Self-Injury 18 23 32 17 47 Emergency Communicati 0 0 0 22 21 Im plem enting S afety Tem plates in E lectronic H ealth R ecords forC hildren w ith ASD s 9 5 50 50 18 0 18 0 23 50 23 0 32 0 32 47 32 0 39 17 56 50 17 22 84 11 37 63 47 21 0 10 20 30 40 50 60 70 80 90 PDSA 1 PDSA 2 PDSA 3 PDSA 4 PDSA 5 DISCUSSION AND CONCLUSIONS
description
LEND Training and Quality Improvement: Building Leadership Skills While Enhancing Patient and Family-Centered Care. Claire Beers, Katherine DiNicola, Marjorie Dobra, Robin Gardner, Carrie Goodberlet, Jed Nordfelt, Johanna Stump Lisa DeLucia, Michelle Casey, Mark Orlando, Stephen Sulkes. - PowerPoint PPT Presentation
Transcript of BACKGROUND
LEND Training and Quality Improvement:Building Leadership Skills
While Enhancing Patient and Family-Centered Care
Claire Beers, Katherine DiNicola, Marjorie Dobra, Robin Gardner, Carrie Goodberlet, Jed Nordfelt, Johanna Stump
Lisa DeLucia, Michelle Casey, Mark Orlando, Stephen Sulkes
BACKGROUND
LEND FELLOW LEARNING OUTCOMES
Unsafe Behaviors• Elopement: Nearly half of children with an
ASD elope, and more than half of these “go missing.” Elopement is associated with autism severity, and is often goal-directed. (Pediatrics 2012)
• Drowning: Children who wander are often drawn to water sources. Accidental Drowning was identified as one of the leading causes of death among children who have a diagnosis of ASD (AWAARE, 2012)
• Pica: Prevalence: 25-30% of children who have a diagnosis of ASD Pica can lead to: Lead Poisoning, Bowel Problems, Intestinal Obstructions or Perforations, Dental Problems, and Parasitic Infection
• Aggression: Many children who have a diagnosis of an ASD exhibit aggressive behaviors towards those close to them. This can be challenging to emergency providers who come across a person with ASD.
• Self-Injurious Behavior : Children who have a diagnosis of ASD are more likely to engage in SIB (Schroeder, et. al, 2002) This includes Head, face, or body slapping, banging, biting, chewing, pinching, punching, or scratching. These behaviors can increase during times of stress.
• Ability to Communicate During Emergency: Children who have a diagnosis of ASD often are affected in the area of communication and over 1/3 are unable to communicate basic personal information (AWAARE, 2012).
Anderson C, Law JK, Daniels A, Rice C, Mandell DS, Hagopian L, Law P. Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders. Pediatrics 11/12; 130(5):1-8, 11/12.
AWAARE Collaboration. (2012). Become Aware. Retrieved from http://www.awaare.org/index.htm
Centers for Disease Control and Prevention. (2012). New Data on Autism Spectrum Disorders (ASDs). Retrieved from http://www.cdc.gov/Features/CountingAutism/
Interactive Autism Network (IAN). (2012). Challenging Behaviors. Retrieved from http://www.iancommunity.org/cs/challenging_behavior/
PDSA Cycle Results: Percent Documented
Kirch Center Safety Resource List
OBJECTIVES – This study
Cycle Descriptions:Cycle 1: Baseline
One Randomly selected week in October, 201122 charts reviewed
Cycle 2: Providers Informed of Activity; no specific intervention proposed
After informal presentation to Kirch Practitioners of QI project
One randomly selected week in December, 2011Cycle 3: Small Group Template Implemented
5 Practitioners volunteered to utilize a Template called “Symptoms”
Reviewed from week of January 30, 201219 charts reviewed total
Cycle 4: Template Presented to Full TeamFormal presentation to Kirch Practitioners in
February First week in April, 2012Total of 20 charts reviewed
Cycle 5: New Electronic Medical Record in Place with Adjustable Templates
Five months after new EMR implemented19 Charts reviewed
DESIGN/METHODS RESULTS
PLAN-DO-STUDY-ACT (PDSA) CyclesA Tool for Incremental Improvement
The Problems
• The CDC created a new ICD-9 Code for Wandering and Elopement (V40.31) based on the interest and high rates reported by major autism groups (2012).
• AWAARE and IAN , for example, reported wandering rates from 50% to high as 92% (2012).
• Only 14% of patients said they received information from medical professionals (IAN, 2012).
• The Golisano Children’s Hospital Kirch Center serves a large population with Autism Spectrum Disorders and wants to become proactive in using the CDC Codes and promoting understanding about wandering.
• Other key autism related safety issues associated with wandering were also identified and incorporated into the study to see if they were being reported and discussed.
• Notation in a Medical Center/Community-wide Electronic Medical Record alerts providers in multiple settings of risks
Five Chart Reviews / PDSA Cycles were conducted in the Kirch Clinic
• Four reviews conducted of all practitioners during follow-up visits
• One review conducted of practitioners who volunteered to use behavioral template
Chart Selection Criteria:• First two patients over age three seen during that
week by each practitioner with diagnosis of ASD or PDD-NOS
References
Initial clinical team resistancePractitioners tend to focus on what they feel is
important during patient visits. Their time is very limited and they like to address the immediate concerns of the patient, leaving less time for documentation of other screening
Needed resources to implement changeseRecords was not live during at start of project and
AllScripts did not have an easily accessible template. With implementation of new system, quality markedly increased
Practitioners, recognized the importance of the risk-areas and given the right tools, change how their practice
Produced a safety resource list (paper and electronic)
Spread awareness across the Kirch Developmental Center of Autism Risk Areas
Wandering Safety:www.AWAARE.orgwww.Autism_Risk_Management.comwww.Project_Lifesaver.orgwww.UNYFEAT.org (Autism Risk and Safety section)
Drowning Prevention and Water Safety:www.warnonline.org/english/index.htmlautism.fsu.edu/documents/DrowningBrochureDRAFT.pdf
Pica Prevention:www.healthguideinfo.com/autism-treatment/p114419/
SIB and Aggressionwww.autism.com/ind_self-injurious_behavior_treat.asphttp://Autism-help.org/behavior-intro-autism.htm
Literature Review SkillsUnderstand Quality Improvement Process and Use of PDSA
Cycle Approach to Incremental ChangePresentation and Interdisciplinary Team Engagement SkillsQuantitative SkillsNegotiation and Conflict ResolutionSystems Change to Achieve Family-Centered CareAdvocacy with Medical Center to add codes to electronic
medical record system
Risk Area PDSA #1 %n = 22
PDSA #2 % n = 22
PDSA #3 %n =20
PDSA #4 %n = 19
PDSA #5 %n = 19
Elopement 9 18 32 39 84
Drowning 5 0 0 17 11
Pica 50 23 32 56 36
Aggression 50 50 47 50 63
Self-Injury 18 23 32 17 47
EmergencyCommunication
0 0 0 22 21
Implementing Safety Templates in Electronic Health Records for Children with ASDs
95
50 50
18
0
18
0
23
50
23
0
32
0
32
47
32
0
39
17
5650
1722
84
11
37
63
47
21
0102030405060708090
PDSA 1
PDSA 2
PDSA 3
PDSA 4
PDSA 5
DISCUSSION AND CONCLUSIONS
